Department of Ophthalmology, Yale University School of Medicine, New Haven, Connecticut.
Semin Plast Surg. 2007 Feb;21(1):47-53. doi: 10.1055/s-2007-967748.
Cosmetic botulinum toxin type A (Botox, Allergan, Inc., Irvine, CA) has revolutionized minimally invasive treatment of the upper face. Increasingly sophisticated outcomes result in facial symmetry in motion. The face is a three-dimensional moving unit, not an isolated photograph. This is why the advanced injector must hone an astute ability to observe casual microexpressions. Consideration is then given to the patient's age, facial anatomy, facial asymmetry, and dynamic rhytids. The ratio of dosing to agonist and antagonist muscles that allows unopposed action is determined. Nuance in placement and dose combined with adjunct therapy results in natural and appropriate facial emotion and avoids unnatural or bizarre patterns of movement. Asymmetrical scenarios are presented to exemplify this process of analysis and treatment. Many authors have detailed the mechanism of action, history of Botox development, and specific muscle group treatment in the periorbital region. In this discussion, I leave behind rigorous academic analysis and wish to offer my approach, which has evolved through 15 years experience treating the aesthetic patient with Botox. The clinician can read about recommended patterns of injection, and the procedure is quite simple. It is only through skilled observation and understanding of expressive nuance and anatomy that the advanced injector will meet the goal of a natural communicative result with chemodenervation. Experience is accumulated through critical analysis of patient results over time. This discussion first directs attention to why it is important to learn how to look at the face in motion as well as at facial rhytids. A plan is developed for treatment including drug preparation, dosing decisions, precise three-dimensional delivery, and adjunct therapy. Perils may generally be avoided by choosing appropriate dosing and placement. The asymmetrical patient scenario is used to demonstrate nuance in evaluation and treatment.
美容用肉毒毒素 A 型（Botox，Allergan，Inc.，Irvine，CA）彻底改变了微创治疗上面部的方法。日益复杂的结果导致面部在运动中更加对称。面部是一个三维运动单位，而不是孤立的照片。这就是为什么高级注射师必须磨练敏锐的观察能力以捕捉偶然的微表情。然后考虑患者的年龄、面部解剖结构、面部不对称和动态皱纹。确定允许拮抗肌拮抗作用的给药与激动剂肌肉的比例。位置和剂量的细微差别以及辅助治疗可产生自然和适当的面部表情，避免不自然或奇异的运动模式。呈现不对称情况来说明这种分析和治疗过程。许多作者详细介绍了肉毒毒素的作用机制、发展史以及眶周区域特定肌肉群的治疗方法。在本次讨论中，我不再进行严格的学术分析，而是希望提供我在使用肉毒毒素治疗美容患者 15 年中积累的经验。临床医生可以阅读关于推荐注射模式的文章，该过程非常简单。只有通过对表情细微差别和解剖结构的熟练观察和理解，高级注射师才能通过化学去神经作用实现自然交流的目标。经验是通过随着时间的推移对患者结果进行批判性分析而积累的。本次讨论首先将注意力引向为什么了解如何观察运动中的面部以及面部皱纹非常重要。制定了治疗计划，包括药物准备、剂量决策、精确的三维给药和辅助治疗。通过选择适当的剂量和位置，通常可以避免风险。使用不对称患者的情况来说明评估和治疗中的细微差别。
